Principle: A registered member of the profession should refrain from entering into, or being part of any transaction or agreement, which may reflect negatively on his or her professional independence or the professionalism, or ethics of the profession as a whole.
In adhering to this principle the following should be taken into consideration:
1.6.1 General Guidelines
| (a) | Pharmacists should not agree to practise under terms or conditions that interfere with or impair the proper exercise of professional judgment and skill, that cause deterioration of the quality of professional services rendered, or that require consent to unethical conduct. |
| (b) | Pharmacists may not collude with any person who is precluded in terms of the Regulations relating to the ownership and licensing of pharmacies from owning a pharmacy or have a beneficial interest in a pharmacy. |
| (c) | While the closest professional co-operation between pharmacist and medical practitioner or other health care professional is to be welcomed, the pharmacist— |
| (i) | must ensure that patients have the freedom to choose where they obtain their pharmaceutical services; and |
| (ii) | must, whenever possible, ensure that patients have given their consent to their prescription being directed to a specific pharmacy. |
1.6.2 Multi-professional (group) practice(s)
In any multi-professional (group) practice the following principles should be adhered to—
| (a) | professional accountability — health professionals are personally accountable for compliance with all ethical rules, policies, standards, codes of conduct and legislation which regulate their respective professional activities; |
| (b) | professional independence — professional independence must be ensured so as to support the principle of professional accountability; |
| (c) | professional responsibility — professional practitioners must assume responsibility only within their scope of professional competence and accountability. Where necessary, patients should be referred to the most appropriately trained practitioner. |
| (d) | peer review and practice parameters must be encouraged within the multi-professional (group) practice to promote efficient, effective and safe practice; |
| (e) | equal norms and requirements — policies, ethical rules and codes of conduct must be applied consistently in all health care delivery systems, including solo practices; |
| (f) | client/patient/community interest — all multi-professional (group) practice activities must be for the benefit of the patient who must be protected from potential exploitation; |
| (g) | freedom of referral — appropriate and necessary referrals must be unrestricted; |
| (h) | shared resources — health professionals may share facilities, equipment, clinical records and support staff, subject to the principles of professional and ethical accountability, independence and responsibility; |
| (i) | any place wherein or from which acts specially pertaining to the scope of practice of a pharmacist are performed, is defined as a pharmacy in terms of the Pharmacy Act; |
| (j) | all pharmacies in multi-professional (group) practices must be properly licensed with the Department of Health and recorded with Council; |
| (k) | all premises must conform with the rules relating to good pharmacy practice as determined by Council; |
| (l) | all pharmacies must be under the control of a responsible pharmacist in terms of applicable legislation; |
| (m) | the pharmacy within a multi-professional practice must be clearly demarcated. |
| (a) | A patient may be issued with prescriptions intended for dispensing at a specified pharmacy but must have the right to present it for dispensing at any pharmacy of his/her choice. A pharmacist must not approach a medical practitioner or medical practice staff to secure direction of prescriptions to a particular pharmacy. A prescription should only be sent directly from a medical practice to a pharmacy when: |
| (i) | the patient has requested the direction; or |
| (ii) | the patient is in residential care and has indicated his/her wish that the person providing that care may collect or receive prescriptions on his/her behalf; or |
| (iii) | the patient has an addiction problem and receives medication in defined, pre-arranged quantities. |
| (b) | A pharmacist shall not offer or give inducements to any person in consideration of the supply to him/her of either prescriptions or orders for medicines, devices or appliances for patients. |
| (c) | In order to prevent perverse incentives, it is neither permissible nor ethical for a pharmacist, pharmacist intern or pharmacist's assistant to engage in the following actions— |
| (i) | advertise or endorse or encourage the use of any health establishment or medicine, complementary medicine, veterinary medicine, medical device or scheduled substance or health related product or health related service in a manner that unfairly promotes the practice of a particular health care professional or health care facility for the purpose of improper financial gain or other valuable consideration; |
| (ii) | engage in or advocate the preferential use of any health establishment or medical device or health related service or sell any medicine, complementary medicine, veterinary medicine or scheduled substance, if any improper financial gain or other valuable consideration is derived from such preferential use or prescription or the advocacy of preferential use by the health care professional, unless entitled by law; |
| (iii) | referral of clients or patients to any health establishment or to other health care professionals if such referral would constitute over servicing; |
| (iv) | accept commission or any financial gain or other valuable consideration from any person(s) or body or service in return for the purchase, sale or supply of any goods, substances or materials used by the health care professional in his or her practice; |
| (v) | pay commission or render any financial gain or other valuable consideration from any person(s) or body or service in return for the purchase, sale or supply of any goods, substances or materials used by the health care professional in his or her practice; |
| (vi) | charge or receive a fee for services not personally rendered by the pharmacy. |
1.6.4 Undesirable business practices
| (a) | A pharmacist must not participate in any transactions or agreements, which runs counter to the patient interest or clinical needs; and/or where patient or health practitioner choice is limited and/or unduly influenced by the existence of such a transaction or agreement. |
This provision includes transactions or agreements where the determining factor in the ordering, stocking and/or dispensing of medicines and/or the provision of advice relating to medicines, is the existence of such a transaction or agreement with any party, individual or institution.
Reference to the provisions of the following act, rule or regulation applying to pharmacists can be made, but it is not an exhaustive list with regard to the above:
| • | Section 43 of the Pharmacy Act 53 of 1974 |
| • | Regulations relating to Ownership and Licensing of Pharmacies contained in the Pharmacy Act 53 of 1974 |
| • | Sections 18(A), (B), (C) of the Medicines and Related Substances Act 101 of 1965 |
